Antidepressants Blog

Women play an important role in educating their children about AIDS (and about other STDs of course, but AIDS is the most likely subject to come up because it has had so much publicity). Children will have heard of it from radio and television and from reading the news, and perhaps from school teachers or talking to other children. It’s important that parents ensure children have clear and accurate information and that they have no unjustified fears about how HIV can be caught. What you say depends on your child’s age and maturity and the circumstances in which the subject is brought up. Some of the pamphlets on AIDS contain information and illustrations suitable for teaching children of various ages.

Preschool children

Preschool children may be too young to grasp the concept of such an illness and are unlikely to ask questions. However, this is a good age to start teaching habits of hygiene that protect against the spread of infections in general (for example, avoidance of contact with other people’s blood, saliva, urine, faeces, discharges and wounds). Also, you can put in some good groundwork for future teaching about AIDS and other sexual matters by encouraging your small children to be as much at ease with and interested in their genitals (including talking and asking about them) as with other parts of the body. This may be hard if you grew up knowing that it was OK to talk about tonsils or lungs, but that mention of the vulva or penis resulted in embarrassment and avoidance (which lads sense and remember even before you’re aware of it yourself). If you want your children to feel free to ask you important sex-related questions when they’re older, you must let them know right from the start that you’re ‘askable’.

Primary schoolers

The appropriate age to explain more about AIDS is somewhere between 6 and 12 years. It is recommended that parents should bring up the subject rather than waiting to be asked: children may be uneasy about raising a topic that involves such difficult things as sex and death. A newspaper headline or television programme may provide a good opening.

Teenagers

Your teenage children will have read and heard as much as you have, but may not have a mature understanding of this information. Discussion of AIDS with teenagers must be frank and accurate, and provides a good opportunity to reinforce teaching about personal hygiene, safe sex and the use of condoms (which also provide contraception), and the potential dangers of drugs. Many parents find these subjects very difficult, but there is plenty of evidence that teenagers are less likely to run into problems with sex and drugs if these matters are discussed at home.

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This describes urinary frequency and pail on urination, usually related to sex, but with no bacteria in the urine. There’s usually no temperature, no pain in the lower abdomen and often little or no urgency. Attacks are often recurrent and may begin after having a catheter in the bladder, after childbirth or surgery, or after a bacterial infection.

The symptoms are probably the result of mechanical trauma to the urethra by the thrusting of the penis during intercourse. Chronic inflammation around the bladder base, where the urethra starts, may also flare up and cause symptoms after sex. Urethral symptoms occasionally arise from the pressure of the rim of a diaphragm. They are also more likely at certain times such as during a viral infection, emotional upsets, when overtired or under any circumstances that reduce sexual arousal and increase the likelihood of frictional trauma to the urethra during intercourse.

Women who get urethral syndrome aren’t helped by antibiotics unless infection is also present, though often these are prescribed over and over again. The inflamed urethra settles down of its own accord after a couple of days without sex or whatever else is irritating the urethra. The antibiotics usually get the credit. But if further intercourse brings back the symptoms while you’re still finishing your course of antibiotics, you can be pretty sure that infection isn’t the cause.

The best way to conquer the after-sex urethral syndrome is to make sure you’re always properly aroused and lubricated before penetration. This won’t be easy if you’re worried about the outcome or if the problem has put you right off sex. It can help to use a lubricating jelly until you gain confidence in knowing that you can enjoy sex without developing urinary symptoms. Postmenopausal women who are not on hormone replacement will mostly need to use extra lubrication.

Other things can irritate the urethra and lead to symptoms. Your urethra can become inflamed, even if not infected, if you have vaginal and genital inflammations and infections.

Other irritants include soap, bath salts and foams, talcum powder, ‘feminine hygiene’ products (which we can all do without), pressure from a tampon in the wrong position, or synthetic underpants. Some people get urethral irritation a few hours after a spicy meal or other foods and drinks (including vitamin C) that make urine acid. (Always wash your hands thoroughly before going to the toilet after handling chillis. The slightest trace transferred when you’re drying your bottom can leave you stinging for hours! As you’ve guessed, this advice comes from an uncomfortable personal experience!)

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Uterine adenomyosis

Adenomyosis means ‘gland within the muscle’. In this condition fragments of endometrium penetrate and grow between the muscle fibres of the uterine wall. It is really endometriosis of the uterine wall,
and may accompany endometriosis elsewhere in the pelvis. Adenomyosis is most common in women who are over 35 years of age.

Symptoms occur because the endometrium within the muscle undergoes the same changes during the menstrual cycle as that lining the uterine cavity. Periods become heavier and more prolonged, and are often associated with a dull ache and a feeling of pressure in the pelvis. The uterus becomes enlarged and softer, and may be tender.

Treatment of adenomyosis is the same as for endometriosis elsewhere in the pelvis, but unfortunately the response to hormones is not generally as good. In women who want no more children, hysterectomy is usually the best solution.

Endometrial hyperplasia

This is overgrowth of the endometrium resulting from prolonged stimulation by oestrogen without the balancing effect of progesterone. Endometrial hyperplasia occurs in women who don’t ovulate for a long time, and is most common in the years preceding the menopause.

There are two exceptions in which the connection between this condition and failure to ovulate does not apply.

• Young women often don’t ovulate for some months or years after the menarche. Periods may be heavier during this time, but as soon as ovulation begins, progesterone from the corpus luteum corrects the endometrial overgrowth.

• Hormonal contraception stops ovulation, but the progesterone it contains prevents endometrial overgrowth. In fact, the combined Pill or contraceptive progestogens are often used to correct endometrial hyperplasia.

The symptom of endometrial hyperplasia is increasingly heavy and prolonged menstrual bleeding, often quite irregular. Diagnosis is by examination under the microscope of endometrium removed by curettage. D&C often stops the heavy bleeding for a few months, but as long as the ovaries continue to produce oestrogen without ovulation, the condition will recur.

The treatment for endometrial hyperplasia is usually to give progestogens. In young women, taking the contraceptive Pill for several months may correct the condition. Endometrial hyperplasia is a benign condition but if it isn’t controlled, it’s possible that prolonged stimulation by oestrogen could lead to endometrial cancer. For this reason, hysterectomy is often advised for women over the age of 40 who want no more children.

Cancer of the uterus

This usually means cancer of the endometrium (lining of the uterus), which is the second most common pelvic cancer in women (after cervical cancer).

Endometrial cancer is much I treacherous than either ovarian or cervical cancer. It develops slowly and can usually be detected early because it almost causes symptoms of irregular or post menopausal bleeding before it spreads.

The cause of endometrial cancer a clear, but it seems to be connected with oestrogen. It is more common among women over the age of 50 who have been exposed to high levels of oestrogen and lack of progesterone, such as those who’ve had endometrial hyperplasia, polycystic ovarian syndrome, or hormone replacement with oestrogen alone. But not all women with a history of these conditions develop endometrial cancer. It’s suspected that the endometrium of those who do is more sensitive to oestrogen stimulation and overgrowth.

The treatment is primarily removal of the uterus, tubes and ovaries by surgery, and may be curative if there’s been no spread. The ovaries are removed because they might contain minute spots of cancer, and because any oestrogen produced might stimulate tiny groups of cancer that have spread elsewhere. If there’s obvious spread when the cancer is nosed, surgery is usually followed by radiation therapy and sometimes treatment with progestogens.

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Primary amenorrhoea is the failure to start menstruating during puberty. When a woman stops menstruating at any time between the menarche and the menopause, it’s called secondary amenonhoea.

Primary amenorrhoea

Ninety-five per cent of girls have had their first period by the age of 16 years. Those who haven’t started menstruating by this age (earlier if there’ve been no other signs of puberty by the age of 14) should see their doctor to discover if there is any particular problem that needs correcting. Many will just be ‘late starters’, but it’s important to treat the following causes of primary amenorrhoea.

Underweight Sometimes failure to start menstruating is an important clue to anorexia nervosa, and this should always be suspected if menstruation hasn’t started or has stopped in a young woman who is extremely thin.

Imperforate hymen

Congenital abnormalities of internal reproductive organs Very rarely, the ovaries, uterus or vagina may not develop properly before birth.

Hormonal disturbances Many hormonal disturbances can lead to primary amenorrhoea.

• If the hypothalamus or pituitary glands are underactive, all the developments of puberty will be delayed or disturbed

• If the ovaries can’t respond to pituitary hormones, there may be a growl spurt but secondary sexual characteristics won’t develop without ovarian hormones.

• Underactivity of the thyroid gland (hypothyroidism) usually results in disturbed puberty and delayed menarche

• Overactivity of the adrenal glands (adrenal hyperplasia) can lead to an over production of male hormones that counteract ovarian hormones.

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If something can be done to treat any cause found, the treatment and reason for it will be explained to you so that you can decide whether you want to go ahead. Such treatments include measures to improve the sperm count or reduce sperm antibodies, drug therapy to stimulate ovulation and procedures to correct blocked tubes.

Improving sperm count First, reducing excessive smoking and drinking is advised; any general health problems are given attention and if drugs or occupational factors are suspected, these should be eliminated if possible. If there is a problem with the hormones that control sperm production (rare), in many cases this can be corrected. Surgery may be attempted to open up any block in the tubes that carry the sperm into the semen, though the success rate of these procedures is low. A varicocele can be removed surgically; this results in increased sperm production in some but not all cases.

Reducing sperm antibodies To suppress the immune system and formation of antibodies, medication with cord steroids may be offered.

Stimulating ovulation If you’re not ovulating, you’ll be advised to have further tests to find out exactly how the hormonal control of ovulation is disturbed. Until quite recently there wasn’t much hope for women who didn’t ovulate. Today the so-called ‘fertility drugs’ will produce ovulation in almost all women who use them. These drugs include clomiphene, gonadotrophins, bromocriptine and gonadotrophin-releasing hormone (Gn RH). Clomiphene and GnRH stimulate the pituitary gland to produce more FSH and LH. Gonadotrophins are tried when pituitary can’t be made to produce its own. Bromocriptine is used when ovulation stops because there is too much prolactin in the circulation.

The use of drugs that stimulate ovulation is very complicated; they are usually prescribed and monitored by fertility specialists in centres with close access special laboratories, as regular (sometimes daily) blood tests must be done on the patient to check progress and work out the next dose. You should have explain to you what this treatment entails, such as the frequency of specialist visits required, chances of success, the possible side-effects, the risk of multiple pregnancy and the cost. Ask about these things.

If you’re very underweight, you may encouraged to eat up and gain some weight before starting the treatment stimulate ovulation. On the other hand, if you’re very overweight you may need to lose some.

Surgery for blocked tubes What can be done depends on the cause and extent of the blockage. This is delicate, painstaking surgery (called tuboplasty) and as the canal through the tube is only 1 mm or so wide in some parts, microsurgery techniques are used.

Even if the tube can be opened, fertility can’t be guaranteed. Scar tissue may form after surgery and re-block the tube. The tubal lining, which has an important role in the safe passage of the fertilised egg through the tube, may have been damaged by whatever caused the blockage in the first place. No matter how skilful the surgeon, it may be impossible to restore the function of a badly damaged tube.

Your surgeon, after looking at the outside of your tubes through the laparoscope and maybe inside by falloposcopy, will give you a realistic opinion about whether it’s worth trying to repair the canal through your tubes and the chance of pregnancy afterwards.

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